Guidance for PACE and Part D Sponsors on COVID-19 Prescription Antivirals
The Centers for Medicare and Medicaid Services (CMS) has issued guidance on expectations for Part D sponsors and Programs of All-Inclusive Care for the Elderly (PACE programs) to optimize access and limit cost sharing to COVID antivirals, in light of the recent introduction of Paxlovid and Lagevrio into the commercial market.
Prior to the Nov. 1st entry of both therapeutics into the commercial market, these antivirals were only available through the U.S. Government Distribution Program. Now, pharmacies can access these therapeutics through both the government program and the commercial market. The recent CMS memo outlines expectations for Part D sponsors to ensure appropriate claims processing for the antivirals. More is available in the memo here.
The guidance is intended to ensure that claims for oral antivirals are processed appropriately to serve the goals of ensuring beneficiary access to these medications at no cost sharing for as long as possible and utilizing supply that has already been procured by the U.S. government.
Contact: Karen Lipson, klipson@leadingageny.org